Stingray Envenomation Follow-up
- Author: John L Meade, MD; Chief Editor: Scott H Plantz, MD, FAAEM more...
Further Outpatient Care
Give patients explicit instructions regarding attention to local wound care and advise them to watch for infection. Requesting that the patient seek a wound check in 2-3 days (with a family doctor or at the ED) is not unreasonable.
It is especially vital that the patient understands that for any sign of infection with Vibrio organisms, time is of the essence in returning to the ED for immediate care.
Inpatient & Outpatient Medications
Prescribing oral narcotics for patients to use as needed upon discharge is appropriate.
When stepped on, the stingray reflexively strikes out, causing the injury to the person who stepped on it. Advise patients to walk in the shallow areas of the beach with a shuffling gait. This is effective in causing stingrays to move away and help decrease the possibility of accidentally stepping on a stingray.
Stingray injuries (eg, puncture wounds, lacerations, envenomations) tend to have good outcomes. If patients do not develop infection or other complications, they can expect to have minimal pain in 24-48 hours and healing within 1-2 weeks.
Following is an example of discharge instructions that could be given to patients after treatment of stingray injuries.
Because so many areas of water are nearby, many types of injuries associated with being in or near the water are encountered. These injuries may occur while fishing, walking on the beach, playing in the surf, diving, or working with a home aquarium.
Stingrays often cause lacerations and puncture wounds when the tail whips up and thrusts its spines into the victim, injecting venom (poison). The pain is severe immediately and worsens over the next hour. The pain may last 48 hours. Although rare, deaths have occurred from stingray injuries.
As soon as possible, the wound should be soaked for 30-90 minutes in very hot water (as hot as can be endured without causing burns). The heat inactivates the poison and dramatically relieves the pain. The physician may prescribe pain medication. Also, because the risk of infection is very high, antibiotics are given to prevent infection.
Despite the best of care, any wound can develop infection or other complications. If any of the following occur, it is recommended that patients call their own doctor, the referral physician, or clinic (If a physician cannot be contacted, return to the ED is advised.):
Wound drainage increases, shows pus, or develops a foul odor
Wound bleeds heavily
Wound becomes more sore or swollen
Wound develops increasing redness, or red streaks develop
A fever develops
Wound does not appear to be healing properly
Any other new or worsening symptoms that are of concern
de Haro L, Pommier P. Envenomation: a real risk of keeping exotic house pets. Vet Hum Toxicol. 2003 Aug. 45(4):214-6. [Medline].
Campbell J, Grenon M, You CK. Pseudoaneurysm of the superficial femoral artery resulting from stingray envenomation. Ann Vasc Surg. 2003 Mar. 17(2):217-20. [Medline].
O'Malley GF, O'Malley RN, Pham O, Randolph F. Retained Stingray Barb and the Importance of Imaging. Wilderness Environ Med. 2015 Sep. 26 (3):375-9. [Medline].
Fenner PJ, Williamson JA, Skinner RA. Fatal and non-fatal stingray envenomation. Med J Aust. 1989 Dec 4-18. 151(11-12):621-5. [Medline].
Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. 2004 Feb 15. 69(4):885-90. [Medline].
Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med. 2007 Jul. 33(1):33-7. [Medline].
Ellenhorn MJ. Envenomations: bites and stings. Ellenhorn's Medical Toxicology. Lippincott Williams & Wilkins; 1997. 1737-98.
Guenin DG, Auerbach PS. Trauma and envenomations from marine fauna. Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 1996. 868-73.
Otten EJ. Venomous animal injuries. Rosen P, et al, eds. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998. 924-40.